Mucosal bridge as a cause of dysphagia after surgery for esophageal atresia.

Abstract

Division of Gastroenterology, Department of Pediatrics, CHU Ste-Justine, Montreal, Quebec Correspondence: Dr Christophe Faure, Division of Gastroenterology and Nutrition, Hopital Sainte-Justine, 3175 Cote Sainte-Catherine, Montreal, Quebec H3T 1C5. Telephone 514-345-4931 ext 2561, fax 514-345-4999, e-mail christophe.faure@umontreal.ca Received for publication May 16, 2014. Accepted June 16, 2014 CASE PRESENTATION Esophageal atresia (EA) is a congenital disorder that affects one in 2500 newborns (1). In the long-term follow-up of these patients, dysphagia is a frequent complication after EA repair. The authors describe three patients presenting with dysphagia after surgical repair of type C EA for whom a treatable cause was found. Two of these patients underwent surgical correction on the first day of life, which was complicated by an anastomotic leak. In the third patient, surgery was postponed to five months of life due to low birth weight and prematurity, rendering reanastomosis technically difficult. All three patients underwent a barium swallow due to persistent dysphagia at six, 13 and 15 years of age, respectively. Esophageal diverticulae were present in two patients, but none had esophageal strictures (Figure 1). Upper endoscopy revealed a mucosal bridge slightly above the anastomotic site (Figure 2). Two patients showed dramatic improvement of their dysphagia after resection of the mucosal bridge using argon plasma coagulation (Figure 3). The mucosal bridge was not excised in the third patient, whose dysphagia remained. DISCUSSION The etiology of these mucosal bridges is unclear, but may be a consequence of surgery, trauma from nasogastric tube placement (2) or gastroesophageal reflux disease (3). Alternatively, mucosal bridges may also be a consequence of inflammation (4) caused by chronic food stasis due to esophageal dysmotility, which was present in all three of our patients, as confirmed by manometric studies (5).